5HT #125: pharma goes DTC, AI’s impact on body image, and 3 more

Remember when pharma company brands sucked? 

Nobody could name one. Everyone hated them. They only entered your mind when a headline hit about a price hike nobody could defend, or some new way they were accused of squeezing people.

Well, that era is over. 

Say hello instead to the DTC pharma era, where some of the best consumer health brand work I’ve seen is coming from a 150-year-old drugmaker in Indianapolis.

How did we get here? The shift started with COVID. As we debated Pfizer vs. Moderna, pharma companies finally became brands we recognized and had opinions about. Then GLP-1s blew the doors off the whole shebang. Everyoneee wanted the drugs, wanted them badly, and wanted them as cheaply as possible. 

So pharma (genius) started cutting out the middle.

Eli Lilly launched LillyDirect in January 2024, creating a direct path to cash-pay medications. You still need a prescription, but if you’re paying cash, you can skip the PBM, (sometimes) skip the pharmacy, skip the insurance approvals, and skip basically everything. And it’s working: Lilly recently shared on an earnings call that self-pay accounted for approximately 45% (!) of total Zepbound prescriptions in Q2 and that much of that was coming through LillyDirect.

And it’s not just Lilly. Novo (which just rebranded from Novo Nordisk for, you guessed it, DTC reasons!) launched NovoCare Pharmacy, Pfizer launched PfizerForAll, and AstraZeneca launched AstraZeneca Direct. Tons of pharma brands are piling in. 

There’s sooo much opportunity here, and I have 4 predictions for what happens next:

1️⃣ Healthcare marketing is about to get interesting. I think we’re going to see the most interesting decade of healthcare marketing ever. Lilly is already doing all the things—content, search, ads, and campaigns tackling issues like obesity stigma. Adweek is ramping up its healthcare coverage. Even my content marketing agency, Healthyish Content, has seen more and more interest from pharma co’s going direct. Yes, pharma faces serious marketing restrictions. But companies that follow Lilly’s lead could go from familiar to favorable quickly.

2️⃣ Pharma will get a feedback loop. Previously, there was much less visibility between running a TV ad and a script getting filled. Going direct means a pharma company can potentially gain more visibility into patient data like refill cadence, adherence signals, and drop-off timing. Given the size of the market we’re talking about, no doubt this’ll lead to better feedback loops and delivery mechanisms. For example, consider that about four in 10 GLP-1 patients stop using the drugs within a year. Imagine a pharma company being like, “Come back,” or, “Hey, we see you haven’t gotten your prescription…” Pharma didn’t have that lever before, and now it does.

3️⃣ The middle will get squeezed. Pharma going DTC isn’t good news for brands in the middle (like Hims and Ro) who’ve built their businesses on being the front door to meds people couldn’t easily access. Now, if people can get the same branded medication directly from its manufacturer at a cash price, a subscription fee suddenly feels more like a toll than convenient access. That doesn’t mean these brands are doomed, but they will increasingly have to prove the value of everything around the prescription (clinician access, coaching, complementary products, and ongoing support) they’re using to justify the extra cost. Access alone will no longer be enough. 

4️⃣ It won’t just be GLP-1s. If you can get your GLP-1s directly, why not everything else? I’ve met multiple pharma co’s building DTC-focused HRT & TRT offerings. Why wouldn’t Bausch build a DTC Tretinoin (among the most popular prescription topical retinoids, I use it!) and skincare-focused offering? If LillyDirect keeps growing, why wouldn’t they start offering prescription hair loss drugs (remember, there seems to be a correlation here) too? What if they end up looking more like Ro/Hims and fully cut everyone else out? Feels like an inevitable opportunity akin to Disney going direct with Disney+ and cutting out Netflix and other distributors…

Anyway, do I feel bad about enriching pharma more? Not really, tbh 🤷. I’m actually mostly pro pharma companies charging a lot (within legal limits) and making money because they invest a lot and take a tremendous amount of R&D risk. 

Just look at the graveyard of Alzheimer’s drugs 🪦. One day, someone will make a TON from cracking it, and I think they’ll super deserve it after the bajillions invested along the way. So if going direct makes treatments easier to access while strengthening the incentive to keep innovating, I’m all for it.

Bottom line: Pharma is rebranding from manufacturer to consumer brand, and that’s opening the floodgates to future drug improvements, fewer friction points, and easier access to prescription drugs than ever before.

While everyone was talking about the new foldable iPhone, I’ve had my eye on the new health features. 👀

Now, most of the headline additions aren’t necessarily new in the space. But they do catch Apple up in a wearable race where they’d started falling behind, and that might be enough for now. Fitt Insider put it best, saying “Apple doesn’t need to out-innovate every rival. For now, it just needs to make standard features accessible on the world’s biggest wearable platform.”

The same goes for other consumer health brands. Sometimes the best way to retain trust isn’t to launch the next shiny feature but to make sure you’ve got the basics (or consumer expectations) covered.

As much as I’m a fan of GLP-1s, it’s hard to ignore how “the Ozempic era” has reshaped body standards 🙁. But GLP-1s aren’t the only factor chipping ⛏️ at the body positivity movement. AI has also moved the goalpost as we see more and more AI-generated models/actors in our feeds.

Worse, new research suggests viewing AI-generated images of idolized bodies negatively impacts body image regardless of whether the role of AI is known. So even if you know an AI-generated image is fake, the comparison can still feel real. 

Ultimately, the standards people are comparing themselves to are getting even more unattainable and, in some cases, aren’t even human. My advice to builders: Use only real people and real customers in your marketing to ensure your brand is sending the right message and to avoid blowback.

We’re OFFICIALLY two weeks away from the soft launch of my first CPG brand, Fixie Dust. Two weeks. Whhhhhhat. 🤯

The debut is happening at Founderland on October 1, and now that the day is finally here, I’m feeling, oh I don’t know, like 98% excited, 2% scared.

Between now and October 1, we’re finalizing the pre-launch landing page, sending out samples to friends and family, and finalizing the promo materials for Founderland. 

Here’s a look at one of the concepts our designer put together. 👇

Ultimately, we’re so close to this thing going live that if anything gets in the way now, it’ll definitely be the work of mischevious pixies lolll. 🧚

Okay, y’all voted for my gut protocol next, so I put together everything I use to support my digestive health. It’s not a sexy topic, I know, but we don’t talk about it nearly enough. A survey from Oshi Health (the MVPs of gut health and a Healthyish client) found American adults would rather sit in traffic (45%) or do their taxes (35%) than talk about poop in a social setting. 😆

And yetttt more than half (52%) believe digestive symptoms like abdominal pain, bloating, constipation, diarrhea, and reflux are just “a normal part of life.” As someone who was hit with some mysterious stomach issues many years ago, I’m telling you it’s not. 

After going down a rabbit hole on gut health, here’s what’s been keeping me regular (and avoiding HYROX-ish scenarios 🫠): 

What I eat 🍽️

What I supplement 💊

What I inject 💉

Oh—and I drink loooots of water. Water helps keep things flowing and supports a healthyish balance of gut bacteria.

3 other healthyish things I’m into right now: 

Most clicked last week: This mini fax machine for your text messages.

👋 Who are you again? I’m Derek Flanzraich, and I’m in the business of healthyish. I founded two venture-backed startups–Greatist (👍) and Ness (👎)—and helped dozens of brands you know grow including Ro, GoodRx, Midi, BetterHelp, and LMNT. I now run Healthyish Content, plus a few other healthyish things (like Fixie Dust, launching this fall).

Every Thursday, I share what’s hot, what’s not, and what’s next in consumer health. (Disclosure: I invest in and advise companies in this space—when I cover one, I'll say so.) I sometimes add affiliate links, but they influence my picks zero.

See something smart, strange, or seriously overhyped? Hit reply, I respond to every email.